Fuhrman Dana Y, Nguyen Lan, Hindes Morgan, Kellum John A
Department of Critical Care Medicine, The Center for Critical Care Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Critical Care Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Congenit Heart Dis. 2019 Nov;14(6):963-967. doi: 10.1111/chd.12862. Epub 2019 Dec 2.
There are significant implications for kidney disease in young adults with congenital heart disease. Prior investigations have not focused on the use of urinary tubular biomarkers for the early identification of kidney disease in this growing patient group.
Determine if young adults with congenital heart disease have differences in the baseline concentration of urinary tubular biomarkers when compared to healthy young adults.
DESIGN/METHODS: In a pilot case control study, 30 patients from 18 to 35 years of age with congenital heart disease and a normal serum creatinine were recruited during a routine follow-up visit. In the same age group, 30 control subjects without history of heart or kidney disease were recruited. Urine samples were obtained to measure beta 2-microglobin, alpha 1-microglobin, N-acetyl-B-D-glucosaminidase, liver fatty acid binding protein, kidney injury molecule-1, insulin-like growth factor binding protein 7, and tissue inhibitor of metalloproteinases-2. Comparisons were done using Wilcoxon rank-sum or Fisher's exact test.
No study participants had proteinuria on urine dipstick. Median concentrations of kidney injury molecule-1 were higher (P = .01) and concentrations of insulin-like growth factor binding protein 7 (P = .001) and tissue inhibitor of metalloproteinases-2 (P = .009) were lower in the subjects with congenital heart disease when compared to the control subjects. There were no significant differences between the groups with respect to the other biomarkers.
Our data suggest that young adults with congenital heart disease may have subclinical kidney dysfunction. Lower levels of insulin-like growth factor binding protein 7 and tissue inhibitor of metalloproteinases-2 may indicate an impaired ability to respond to injury, while higher levels of kidney injury molecule-1 may reflect early tubular injury.
先天性心脏病的年轻成年人患肾脏疾病的风险很高。先前的研究未聚焦于利用肾小管生物标志物来早期识别这一不断增加的患者群体中的肾脏疾病。
确定先天性心脏病的年轻成年人与健康年轻成年人相比，其肾小管生物标志物的基线浓度是否存在差异。
设计/方法：在一项前瞻性病例对照研究中，30名年龄在18至35岁之间、血清肌酐正常的先天性心脏病患者在常规随访期间被招募。在同一年龄组中，招募30名无心脏病或肾脏疾病史的对照对象。采集尿液样本以测量β2-微球蛋白、α1-微球蛋白、N-乙酰-β-D-氨基葡萄糖苷酶、肝脏脂肪酸结合蛋白、肾损伤分子-1、胰岛素样生长因子结合蛋白7和金属蛋白酶组织抑制剂-2。使用Wilcoxon秩和检验或Fisher精确检验进行比较。
所有研究参与者的尿试纸检查均未出现蛋白尿。与对照对象相比，先天性心脏病患者的肾损伤分子-1中位数浓度较高（P = 0.01），胰岛素样生长因子结合蛋白7（P = 0.001）和金属蛋白酶组织抑制剂-2（P = 0.009）的浓度较低。在其他生物标志物方面，两组之间无显著差异。
我们的数据表明，先天性心脏病的年轻成年人可能存在亚临床肾功能不全。胰岛素样生长因子结合蛋白7和金属蛋白酶组织抑制剂-2水平较低可能表明对损伤的反应能力受损；而肾损伤分子-1水平较高可能反映早期肾小管损伤。
